Children have a unique ability for healing fractures and remodeling deformities (Figure 1). Although, the physician usually strives to achieve good reduction of fractures in children. However, the surgeon may not be able to achieve acceptable reduction every time. Fractures in children do not always remodel. The deformity may lead to unacceptable results in cosmesis and function.
What are the rules for remodeling in children?
Younger children have a better remodeling potential. The younger, the better. Children with two or more years of growth left will have a chance for remodeling. The periosteum in children is thick and promotes faster healing of the fracture, as well as increased potential for remodeling ability (Figure 2).
The distance of the fracture from the end of the bone is also considered when evaluating the remodeling ability of the bone. A fracture in the metaphysis, near the growth plate, remodels better than a fracture in the middle of the bone (Figure 3). A fracture located in the middle of the bone, away from the growth plate, has less potential for remodeling.
The severity of the angulation can also play a role in remodeling of the bone. When there is minimal angulation, the bone could remodel completely. Where angulation is more severe, the bone will partially remodel (Figure 4). Angulation in the plane of joint movement is most likely to improve with growth and remodeling.
Remodeling of the Deformity
Remodeling means correction. The osteoclasts will resorb the bone from one side by eating that bone. The osteoblasts will lay new bone formation, the periosteal will help with this manner, and the bone will gradually straighten its shape. Remodeling will not improve displaced fractures involving the joint or the growth plate (Figure 5). Joint and growth plate fractures that extend to the joint, should be reduced anatomically and perfectly.
In conclusion, fractures in children usually remodel. The x-ray may not look good, but 6 months from the initial x-rays will look better. The family will need to be reassured that the majority of fractures in children remodel and the child's function will not be affected by the fracture of the little angulation that is noticed.
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